Upload
others
View
8
Download
0
Embed Size (px)
Citation preview
Helena CASSOL PhD student
Steven LAUREYS MD
University Hospital
& University of Liège Belgium
www.comascience.org
Consciousness: Exploring brain activity in
coma & related states of consciousness
Laureys, Trends in Cognitive Sciences, 2005
Laureys et al, Nature Clinical Medicine, 2008
Coma
General Anesthesia
Locked-in syndrome
Minimally Responsive
-command following MCS+
- non-reflex movements MCS-
“Vegetative” unresponsive
Conscious Wakefulness
Drowsiness
St I-II Sleep
St III-IV Sleep
Lucid
Dreaming
REM Sleep
Epilepsy Sleepwalking
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
= necessary but not sufficient
Arousal & awareness
Boly et al, Ann NY Acad Sci, 2009
Vanhaudenhuyse & Demertzi et al, J Cogn Neursoci, 2011
Measuring awareness Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Measuring consciousness
EEG high density
FDG-PET
EEG-TMS
MRI fMRI
Measuring brain activity
Altered states of consciousness
- Pathological : coma
- Pharmacological: anesthesia
- Physiological: hypnosis
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Stender et al, Current Biology, 2016
Consciousness ≠ global brain function Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Consciousness and global brain function
Thibaut et al, J Rehabil Med, 2012
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
“Global workspace” of consciousness
UNRESPONSIVE WAKEFULNESS / VEGETATIVE STATE
MINIMALLY CONSCIOUS STATE
Vanhaudenhuyse, Demertzi et al, J Cogn Neursoci 2010
EXTERNAL or SENSORY
AWARENESS
INTERNAL or SELF
AWARENESS
External & internal awareness Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Boly, Garrido, Gosseries, Bruno, Schnakers, Massimini, Litvak,
Laureys, Friston, Science, 2011
Consciousness ≈ top-down Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Piarulli et al, J Neurol, 2016
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Temporal dynamics of EEG measures
SPECTRAL ENTROPY
MCS
VS/UWS
Diagnostic error after coma
n=103 post-comatose patients – 45 clinical consensus diagnosis ‘vegetative state’
– 18 signs of awareness (Coma Recovery Scale)
30-40% potential misdiagnosis
Schnakers et al, BMC Neurology, 2009
Stender et al, Lancet, 2014
Diagnostic error after coma Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
fMRI-based communication
Monti & Vanhaudenhuyse et al, New Eng J Med, 2010
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Brain Computer Interfaces
Noirhomme et al NeuroImage 2015
Lesenfants, Habbal et al J Neural Engineering 2014
Cruse et al Lancet, 2011, also see Goldfine et al, Lancet, 2013
SCIENCE GROUP
COMA
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Bruno et al, J Neurology, 2012
VEGETATIVE/UNRESPONSIVE
Measuring consciousness Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
support vector machine classifier
Classifying “resting” fMRI Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Vanhaudenhuyse et al, Brain, 2010
Demertzi et al, Brain, 2015
Di Perri et al, Lancet Neurol 2016
Pathological hyper-connectivity Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
EEG-TMS perturbational complexity index in sleep, anesthesia & coma
Casali and Gosseries et al, Science Transl Med, 2013
EEG-TMS Perturbational Complexity Index
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Sarasso et al, Curr Biol, 2015
EEG-TMS Perturbational Complexity Index
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
CRS-R vs FDG-PET vs fMRI
Stender & Gosseries et al, Lancet, 2014
PET
fMRI
130 patients (29/y) 4 excluded (3%) 81 MCS 41 VS/UWS 4 LIS 110 chronic (87%) 78 non-trauma (62%)
35% clinical misdiagnosis
32% CRS-R misdiagnosis
Multi-modal imaging Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Intralaminar nuclei “reconnections” in spontaneous recovery from
“vegetative” unresponsive state
Laureys et al, Lancet 2000 Schiff et al, Nature 2007
Intralaminar nuclei stimulation induces “recovery” from
minimally responsive state
Consciousness ≈ thalamo-cortical Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Intralaminar nuclei “reconnections” in spontaneous recovery from
“vegetative” unresponsive state
Laureys et al, Lancet 2000
Transcranial direct current stimulation (tDCS)
Thibaut et al, Neurology 2014
Consciousness ≈ thalamo-cortical Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Ethical framework
Fins et al, Am J BioEthics, 2008
Ethical framework Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Boly et al, Lancet Neurology, 2008
Pain in minimally conscious state Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Quality of life
Bruno et al, BMJ Open, 2011
Quality of life Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
mesocircuit fronto-parietal model
Laureys & Schiff, NeuroImage, 2012
Giacino, Fins, Laureys, Schiff, Nature Rev Neurol, 2014
Deep brain stimulation
transcranial Direct Current Stimulation
amantadine
zolpidem Scientific - Neural correlates
Medical - Diagnosis - Prognosis - Treatment
Ethical
Paradigms (re)framed by neuroimaging
Consciousness | Neural correlates | Diagnosis | Prognosis | Treatment | Ethics
Contact: